Do hepatic and biliary functional data from gadoxetate-enhanced MRI add value in predicting outcomes in primary sclerosing cholangitis (PSC)?

objectivesTo determine if functional information from gadoxetate disodium-enhanced MRI is useful in assessing prognosis in primary sclerosing cholangitis (PSC). MATERIALS AND

methodsIn this retrospective case-controlled study, 73 patients with PSC and gadoxetate-enhanced MRI were enrolled. Four radiologists independently assessed qualitative and quantitative MRI features. The value of these features in predicting adverse events (liver-related death, hepatic decompensation from grade III/IV hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis as well as need for liver transplantation) within 2 years of MRI were compared with recognized radiological scores as well as clinical scoring systems (Mayo Risk Score, Amsterdam-Oxford model and UK PSC score), using multivariate logistic regression and receiver operating characteristic curve analysis.

resultsThe cohort consisted of 42 males and 31 females, with a mean age of 41.9 years. In the 2-year period after MRI, 26 patients had adverse events, 8 had liver transplantation, and 6 died. On multivariate analysis, only Mayo Risk Score (p = 0.001) and relative enhancement of proximal extrahepatic bile ducts (REPD) (p = 0.035) were significant in predicting adverse outcomes. REPD of < 4.64 had 70% sensitivity and 63% specificity in such an event. The only variable that significantly predicted liver transplantation was ANALI non-gadolinium score (p = 0.0003). ANALI score of > 3 had a sensitivity of 87.5% and specificity of 74.2% for predicting the need for liver transplantation.

conclusionsRelative enhancement ratio of extrahepatic bile ducts at 20 min after gadoxetate disodium provides useful information in predicting adverse events in PSC patients and is complementary or superior to the currently used clinical scoring systems. KEY POINTS: Question Can functional hepatic and biliary parameters, obtained from gadoxetate-enhanced MRI, be useful in predicting adverse events in patients with primary sclerosing cholangitis? Findings The relative enhancement of proximal bile ducts (REPD) was useful in predicting adverse events and the need for liver transplantation within 2 years of MRI. Clinical relevance ANALI score predicts need for liver transplantation and may be included in MRI reports of patients with PSC. REPD is more difficult to measure on a routine clinical basis and may only be useful in drug trials.